Sex has a strong influence on many aspects of well-being: it is one of our most basic physiological needs. Sex feeds our identity and is a core element of our social life.

But millions of people spend at least some of their adulthood not having sex. This sexual avoidance can result in emotional distress, shame and low self-esteem – both for the individual who avoids sex and for the partner who is rejected.

Yet while our society focuses a lot on having sex, we do not know as much about not having it.

As a researcher of human behavior who is fascinated by how sex and gender interact, I have found that sexual avoidance influences multiple aspects of our well-being. I also have found that people avoid sex for many different reasons, some of which can be easily addressed.

In his landmark work, Alfred Kinsey found that up to 19 percent of adults do not engage in sex. This varies by gender and marriage status, with nearly no married males going without sex for a long duration.

Other research also confirms that women more commonly avoid sex than men. In fact, up to 40 percent of women avoid sex some time in their lives. Pain during sex and low libido are big issues.

Chronic pain diminishes the pleasure of the sexual act and directly interferes by limiting positions. The depression and stress it causes can get in the way, as can certain medications for chronic pain.

Metabolic conditions such as diabetes and obesity reduce sexual activity. In fact, diabetes hastens sexual decline in men by as much as 15 years. Large body mass and poor body image ruin intimacy, which is core to the opportunity for having sex.

Social and emotional factors – and consequences

For both genders, loneliness reduces the amount of time spent with other people and the opportunity for interactions with others and intimacy. Individuals who are lonely sometimes replace actual sexual relations with the use of pornography. This becomes important as pornography may negatively affect sexual performance over time.

What is the solution?

Embarrassment, cultural and religious factors, and lack of time may hold some doctors back from asking about the sex lives of their patients. Some doctors feel that addressing sexual issues creates too much closeness to the patient. Others think talking about sexuality will take too much time.

Patients could benefit from a little help. To take just one example, patients with arthritis and low back pain need information and advice from their health care provider about recommended intercourse positions so as to avoid pain.